A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction

Abstract

Backgrounds: The use of eptifibatide combined with heparin during percutaneous coronary intervention (PCI) in patients presenting with ST-elevation myocardial infarction (STEMI) is recommended to be followed by continuous infusion. Recently, there are some suggestions that using bolus only may be sufficient and cost-effective but randomized trials are lacking. Aims: The goal of this study was to evaluate these two approaches in a double-blinded randomized control trial. Methods: The primary PCI patients who received bolus eptifibatide were randomized to 75 mg IV eptifibatide infusion or placebo blindly. The patients were followed up for the primary outcome of vascular or bleeding complications and secondary outcome of ischemic complications. Results: 330 patients ( 165 from each group ) completed the study. The mean age was 57.67 ± 11.53 years and 77.3% were male. Major bleeding was seen in 1 patient in each group. Hematoma occurred in 8.5%. The relative risk of hematoma and ecchymosis in bolus plus in fusion group to bolus only group were 0.988 (95% CI: 0.486–2.006) and 1.032 (95% CI:0.729–1.459). Multivariate analysis confirmed no significant differences in the bleeding event. Furthermore, there was no significant difference in in-hospital death or any ischemic events. (Cath lab death: 1.4% in bolus only vs zero % in the control group, p = 0.217, stent thrombosis was seen in one patient in each group). Conclusion: There were no differences in the risk of access site ecchymosis, hematoma or major bleeding. Ischemic events and stent thrombosis rates were also similar. Our study suggests that using eptifibatide bolus only during PCI of patients with STEMI is safe and can be cost-saving.